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house Bill H.R. 1384

‘Medicare for All’: Should the U.S. Adopt a Single-Payer Healthcare System?

Argument in favor

A single-payer healthcare system is the best way to ensure that all Americans have access to the healthcare they need without having to worry about paying for health insurance. It would be more efficient than the status quo at controlling costs and produce better outcomes while bringing the U.S. in line with other developed nations with single-payer systems.

Ryan's Opinion
···
03/12/2019
As a primary care physician, I take care of a lot of privately insured patients who, despite being insured, still struggle to afford their health care. This comes up several times on a daily basis. We are all sicker and poorer because of the way our current healthcare system is run. Please vote Yes on Medicare for all!
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Les's Opinion
···
04/30/2019
We absolutely should move toward universal healthcare.. Medicare for All. Why keep spending twice as much for half the results.
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Muguette's Opinion
···
05/01/2019
streamlining health care options and insurance will help people stay out of bankruptcy and make managing health services simpler and more affordable so the health care professionals spend less time on the paper work, and more time caring for patients and for themselves.
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Argument opposed

A single-payer healthcare system would concentrate too much power in the federal government, creating inefficiencies in the healthcare market. It would reduce physicians’ pay and consequently the quality of care they provide, and lead to long wait lists for patients to see their doctor — all while imposing a massive tax increase on middle-class Americans.

Maureen's Opinion
···
04/30/2019
There are too many questions about this potential act that go unanswered. It is presented as "all American Citizens health insurance" Further reading refers to everyone receiving free medical care. There are a lot of people in the USA that are not citizens. What happens when people arrive in the USA just to obtain free medical care?
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Holly's Opinion
···
04/30/2019
Not this! Americans should always be able to have choices. Medical providers, insurance providers, and related expenses should all be something Americans can choose. The problem area is the choices are very slim for people who are disabled, impoverished, and otherwise disadvantaged. These are the people who need to have a system that will cover them until and unless they can get out of and improve their negative situations. It would be possible to do so by creating a group or groups which could be funded by federal and state tax dollars. The groups would have choices of Ins. Companies & Med. providers just like they do with other groups who choose from several different agencies and types of coverages. Recipients would pay for it on a sliding fee scale after filling out applications and being checked for whether or not they qualify. It would be strictly enforced and people would be subject to review at least twice a year to see if their status is still the same. I would propose something like this and have it revised by medical and insurance professionals to be something that could be affordable to our tax dollar system knowing that some of the monies would be coming from the insureds. But to make it a blanket single payer across the board system for all Americans is outrageously unconstitutional in my honest opinion. Forcing Americans to pay for something they don't want to pay with regard to other people is just not right. Fortunately, now the penalty for Obamacare is gone. That was absolutely wrong to do to the American people. So many people went without insurance and paid that fine because it's all they could afford to do. Shameful! Take the coverage away from some people so you can give it to others? That's what it did. Even if my solution wouldn't work, something similar to it could.
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DavisTrev's Opinion
···
04/29/2019
Healthcare is a critical priority that has become a political football. It seems like new proposals surface every day, but their differences and consequences are unclear. To make sense of these proposals and how they would affect our daily lives, we need to step back and understand the bigger picture. Americans spend more on healthcare than citizens of other developed nations, yet paradoxically our actual health is worse by many objective measures. This paradox is largely a result of three factors. First, America leaves millions of people uninsured. Americans who lack insurance may forego cost-effective preventative care, allowing chronic illnesses to fester until they're forced to seek more expensive emergency treatment. The outcome is sicker patients who need more costly interventions, all of which wastes money. Then, many people without insurance are unable to pay their high medical bills, so hospitals absorb the costs and recoup these losses by raising everyone else's rates. Second, for-profit insurers siphon off a part of healthcare premiums to pay shareholders, rather than using the premiums exclusively for patient care. This wastes a significant portion of our healthcare premiums in money that doesn't pay for our medical care and instead ends up in the pockets of shareholders even while we may be suffering from preventable diseases. Third, we trust insurers to negotiate on our behalf to lower drug prices and medical charges, but insurers have a perverse incentive to let costs rise. The Affordable Care Act (ACA) caps the spending on administrative costs and returns to shareholders at 20 percent. Limited in this way, insurers are forced to increase total spending every year to provide higher returns to shareholders each year. Insurers must not only increase premiums each year, they must also justify these increases and use rising costs to do this. Thus, the for-profit system incentivizes ever-increasing bloated healthcare charges. We could address these three factors by demanding a universal system that covers everyone, minimizes for-profit insurance, and slows premium increases while improving public health. We should take inspiration from the many other countries that have accomplished such a system. Some countries (like Cuba, Italy, Spain, and the UK) have a government-run national healthcare system that owns the hospitals and directly employs providers. Other countries (like Canada, South Korea, and Taiwan) have nationalized health insurance with privately owned hospitals and independent providers. Still other countries (like France, Germany, Japan, and Switzerland) have an all-payer system with many private health insurance plans, privately owned hospitals, and independent physicians. All-payer systems like these guarantee coverage for everyone by providing government insurance to anyone not enrolled in a private plan. The government insurance then uses its negotiating power with providers on behalf of all payers to gain lower rates that can be used by all insurance carriers. All of these countries, using all these different solutions, cover every one of their citizens with less waste and better health outcomes than in America. Several pathways to universal coverage are already being considered in our Congress. Medicare expansion of some type is at the heart of all these congressional plans, so the effects of expanding Medicare must be carefully considered. For instance, Medicare pays significantly less than private insurers, so expansion of Medicare will reduce provider reimbursements. If expansion happens too quickly, providers will have no choice but to cut jobs abruptly. That would mean less support staff, fewer medical assistants, fewer nurses, and more overworked and underpaid physicians. It might even force hospital closures, affecting the broader US economy. Healthcare is 18 percent of the U.S. economy. Provider reimbursements pay the salaries of about 10 percent of American workers (over 14 million people working at about 6,000 hospitals and in private medical practices). So Medicare changes have potential to harm millions of workers and patients if not carefully planned. Any proposal that would require a rapid change like requiring full implementation of a single-payer system at Medicare rates within just two or four years could cause unintended and undesirable consequences. A more careful and gradual transition like the Medicare For America proposal would be far wiser. Medicare For America would offer a Medicare-option to all consumers on the existing ACA marketplaces while improving medical benefits over current Medicare or ACA plans. In addition to the ACA's mandated 10 essential health benefits, it would cover long-term, dental, hearing, and vision care and have zero premiums or cost sharing for anyone whose income is under 200 percent of the federal poverty level. A Medicare-option plan is not an all-payer system, nor does it completely abandon for-profit private insurance, but it would offer an important step forward in universal coverage, cost control, and quality. Over time enrollment will grow and private insurance may fade away, losing out to direct competition with the more cost-effective Medicare option. The transition would gradually but steadily shift jobs to other sectors with minimal turmoil, perhaps paving the way for an all-payer or single-payer system in the future. If you want universal health insurance coverage, lower costs, and better outcomes, consider contacting your U.S. Representative and Senators in Congress. Ask them to support the Medicare For America proposal on behalf of yourself and your family. They're waiting to hear from you. (https://www.google.com/amp/s/cohasset.wickedlocal.com/news/20190401/commentary-revise-healthcare-with-care%3ftemplate=ampart)
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bill Progress


  • Not enacted
    The President has not signed this bill
  • The senate has not voted
  • The house has not voted
      house Committees
      Military Personnel
      Committee on Energy and Commerce
    IntroducedFebruary 27th, 2019

What is House Bill H.R. 1384?

This bill — the Medicare for All Act — would provide individuals residing in the U.S. with healthcare for all “medically necessary care” under a single-payer healthcare system. Medically necessary care would include primary care, prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care. Patients would be able to choose to receive care from any qualified institution, agency, or individual.

Only public or nonprofit institutions would be allowed to participate. Health insurers would be prohibited from selling insurance that duplicates the benefits provided under this bill, but could sell benefits that aren’t medically necessary such as cosmetic surgery. Healthcare providers would be paid for their operating expenses (like salaries and medical devices) by the government each fiscal quarter based on established compensation guidelines. Costs would be reviewed by a regional healthcare director each quarter.

People currently enrolled in federal healthcare programs through the Dept. of Veterans Affairs (VA) or the Indian Health Service would maintain their current medical benefits and services.

Impact

American healthcare consumers and taxpayers; healthcare providers; insurers; and the federal government.

Cost of House Bill H.R. 1384

A CBO cost estimate is unavailable.

More Information

In-Depth: Rep. Pramila Jayapal (D-WA) introduced this bill to expand Medicare so that every person living in the U.S. “has guaranteed access to healthcare with comprehensive benefits” and offered the following statement upon its introduction:

“Today in America, 30 million people are uninsured. 40 million are underinsured. We have the most expensive healthcare system in the world and yet our outcomes are the worst of all industrialized countries. I and the more than 100 co-sponsors of this bill refuse to allow this to continue. It’s time to put people’s health over profit. Our bill will cover everyone. Not just those who are fortunate enough to have employer-sponsored insurance. Not just children. Not just seniors. Not just those who are healthy. Everyone. Because healthcare is a human right… It is time to ensure that healthcare is a right and not a privilege, guaranteed to every single person in our country. It is time for Medicare for All.”

Jayapal’s bill doesn’t include any tax increases to pay for the increased cost, although she has indicated that she will release a list of potential tax increases (possibly including a “wealth tax” or repealing tax cuts) separately after the bill’s introduction on February 27, 2019. However, no such list has been publicly released or added to her website’s Medicare for All Act resources page as of April 29, 2019.

Detractors argue that a ‘Medicare for All’ single-payer healthcare system would be extraordinarily costly and would have a detrimental impact on the economy. An analysis by the Mercatus Center, a free market-oriented think tank, found that a similar Medicare for All bill sponsored by Sen. Bernie Sanders (I-VT) would cost at least $32.6 trillion over 10 years — or roughly $3.26 trillion per year — a funding gap so large that doubling personal and corporate income taxes couldn’t erase it. The study’s authors say those “estimates are conservative because they assume the legislation achieves its sponsors’ goals of dramatically reducing payments to health providers, in addition to substantially reducing drug prices and administrative costs.” They add:

“A doubling of all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan… M4A would markedly increase the demand for healthcare services while simultaneously cutting payments to providers by more than 40 percent relative to private insurance rates, reducing payments to levels that are lower on average than providers’ current costs of providing care. It cannot be known how much providers will react to these losses by reducing the availability of existing health services, the quality of such services, or both.”

This legislation has the support of 108 cosponsors in the House, all of whom are Democrats.


Of Note: A poll from the Kaiser Family Foundation found that while a majority of respondents favored a Medicare for All national health plan key goals — such as 71% in favor of health insurance as a right and 67% wanting to eliminate health insurance premiums — support for a Medicare for All, single-payer healthcare system drops under the following circumstances:
  • 70% opposed a healthcare system that’d lead to delays in people getting some medical tests and treatments.
  • 60% opposed a plan that’d threaten the current Medicare system.
  • 60% opposed a plan that’d require most Americans to pay more in taxes.
  • 58% opposed eliminating private health insurance companies.

Media:

Summary by Eric Revell

(Photo Credit: mollytkadams via Flickr / Creative Commons)

AKA

Medicare for All Act of 2019

Official Title

To establish an improved Medicare for All national health insurance program.

    As a primary care physician, I take care of a lot of privately insured patients who, despite being insured, still struggle to afford their health care. This comes up several times on a daily basis. We are all sicker and poorer because of the way our current healthcare system is run. Please vote Yes on Medicare for all!
    Like (4)
    Follow
    Share
    Yes. I support this proposal.
    Like (3)
    Follow
    Share
    We absolutely should move toward universal healthcare.. Medicare for All. Why keep spending twice as much for half the results.
    Like (2)
    Follow
    Share
    Not this! Americans should always be able to have choices. Medical providers, insurance providers, and related expenses should all be something Americans can choose. The problem area is the choices are very slim for people who are disabled, impoverished, and otherwise disadvantaged. These are the people who need to have a system that will cover them until and unless they can get out of and improve their negative situations. It would be possible to do so by creating a group or groups which could be funded by federal and state tax dollars. The groups would have choices of Ins. Companies & Med. providers just like they do with other groups who choose from several different agencies and types of coverages. Recipients would pay for it on a sliding fee scale after filling out applications and being checked for whether or not they qualify. It would be strictly enforced and people would be subject to review at least twice a year to see if their status is still the same. I would propose something like this and have it revised by medical and insurance professionals to be something that could be affordable to our tax dollar system knowing that some of the monies would be coming from the insureds. But to make it a blanket single payer across the board system for all Americans is outrageously unconstitutional in my honest opinion. Forcing Americans to pay for something they don't want to pay with regard to other people is just not right. Fortunately, now the penalty for Obamacare is gone. That was absolutely wrong to do to the American people. So many people went without insurance and paid that fine because it's all they could afford to do. Shameful! Take the coverage away from some people so you can give it to others? That's what it did. Even if my solution wouldn't work, something similar to it could.
    Like (1)
    Follow
    Share
    There are too many questions about this potential act that go unanswered. It is presented as "all American Citizens health insurance" Further reading refers to everyone receiving free medical care. There are a lot of people in the USA that are not citizens. What happens when people arrive in the USA just to obtain free medical care?
    Like (1)
    Follow
    Share
    Healthcare is a critical priority that has become a political football. It seems like new proposals surface every day, but their differences and consequences are unclear. To make sense of these proposals and how they would affect our daily lives, we need to step back and understand the bigger picture. Americans spend more on healthcare than citizens of other developed nations, yet paradoxically our actual health is worse by many objective measures. This paradox is largely a result of three factors. First, America leaves millions of people uninsured. Americans who lack insurance may forego cost-effective preventative care, allowing chronic illnesses to fester until they're forced to seek more expensive emergency treatment. The outcome is sicker patients who need more costly interventions, all of which wastes money. Then, many people without insurance are unable to pay their high medical bills, so hospitals absorb the costs and recoup these losses by raising everyone else's rates. Second, for-profit insurers siphon off a part of healthcare premiums to pay shareholders, rather than using the premiums exclusively for patient care. This wastes a significant portion of our healthcare premiums in money that doesn't pay for our medical care and instead ends up in the pockets of shareholders even while we may be suffering from preventable diseases. Third, we trust insurers to negotiate on our behalf to lower drug prices and medical charges, but insurers have a perverse incentive to let costs rise. The Affordable Care Act (ACA) caps the spending on administrative costs and returns to shareholders at 20 percent. Limited in this way, insurers are forced to increase total spending every year to provide higher returns to shareholders each year. Insurers must not only increase premiums each year, they must also justify these increases and use rising costs to do this. Thus, the for-profit system incentivizes ever-increasing bloated healthcare charges. We could address these three factors by demanding a universal system that covers everyone, minimizes for-profit insurance, and slows premium increases while improving public health. We should take inspiration from the many other countries that have accomplished such a system. Some countries (like Cuba, Italy, Spain, and the UK) have a government-run national healthcare system that owns the hospitals and directly employs providers. Other countries (like Canada, South Korea, and Taiwan) have nationalized health insurance with privately owned hospitals and independent providers. Still other countries (like France, Germany, Japan, and Switzerland) have an all-payer system with many private health insurance plans, privately owned hospitals, and independent physicians. All-payer systems like these guarantee coverage for everyone by providing government insurance to anyone not enrolled in a private plan. The government insurance then uses its negotiating power with providers on behalf of all payers to gain lower rates that can be used by all insurance carriers. All of these countries, using all these different solutions, cover every one of their citizens with less waste and better health outcomes than in America. Several pathways to universal coverage are already being considered in our Congress. Medicare expansion of some type is at the heart of all these congressional plans, so the effects of expanding Medicare must be carefully considered. For instance, Medicare pays significantly less than private insurers, so expansion of Medicare will reduce provider reimbursements. If expansion happens too quickly, providers will have no choice but to cut jobs abruptly. That would mean less support staff, fewer medical assistants, fewer nurses, and more overworked and underpaid physicians. It might even force hospital closures, affecting the broader US economy. Healthcare is 18 percent of the U.S. economy. Provider reimbursements pay the salaries of about 10 percent of American workers (over 14 million people working at about 6,000 hospitals and in private medical practices). So Medicare changes have potential to harm millions of workers and patients if not carefully planned. Any proposal that would require a rapid change like requiring full implementation of a single-payer system at Medicare rates within just two or four years could cause unintended and undesirable consequences. A more careful and gradual transition like the Medicare For America proposal would be far wiser. Medicare For America would offer a Medicare-option to all consumers on the existing ACA marketplaces while improving medical benefits over current Medicare or ACA plans. In addition to the ACA's mandated 10 essential health benefits, it would cover long-term, dental, hearing, and vision care and have zero premiums or cost sharing for anyone whose income is under 200 percent of the federal poverty level. A Medicare-option plan is not an all-payer system, nor does it completely abandon for-profit private insurance, but it would offer an important step forward in universal coverage, cost control, and quality. Over time enrollment will grow and private insurance may fade away, losing out to direct competition with the more cost-effective Medicare option. The transition would gradually but steadily shift jobs to other sectors with minimal turmoil, perhaps paving the way for an all-payer or single-payer system in the future. If you want universal health insurance coverage, lower costs, and better outcomes, consider contacting your U.S. Representative and Senators in Congress. Ask them to support the Medicare For America proposal on behalf of yourself and your family. They're waiting to hear from you. (https://www.google.com/amp/s/cohasset.wickedlocal.com/news/20190401/commentary-revise-healthcare-with-care%3ftemplate=ampart)
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    streamlining health care options and insurance will help people stay out of bankruptcy and make managing health services simpler and more affordable so the health care professionals spend less time on the paper work, and more time caring for patients and for themselves.
    Like (1)
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    Share
    it makes it more affordable and u have easy access to doctors and they cant charge what ever they want
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    Not with this demoncrat Bill. Their bills always mean the opposite.
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    The arguments opposed to this have been repeatedly debunked. A single payer system would be cheaper for everyone by cutting out inflated prices & premiums. It does not end private insurance, it doesn't mean that doctors will have to take a huge pay cut, Wait time always varies regardless, and although more people will be going it's not like the whole population is going to rush there for no reason. Adopting a European healthcare system that has proven over and over to be successful & sustainable is something that is long overdue in the US.q
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    I would need to see this Medicare for all bill before I could say yes or no. How is it going to be paid for when you say Social security is going broke by 2035? I would love for everyone to have free health care but is anything really free and what about all the debt Drs carry from their education? Are you going to forgive that so they can make less money? What about malpractice? A lot of unanswered questions.
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    We should be able to have universal healthcare with a single payer. Other countries do and we have not even tried to come close to it.
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    Universal Health Care is Best Approach preferred System however likely will Not be approved to become Law in Our Country lots of Resistance here Peace
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    Beyond the obvious advantage of providing healthcare to everyone, M4A would provide a much needed economic boost to the country when you consider the number people currently employed in healthcare industries, and new employees needed. With everyone in the country having access to the newest diagnostic and corrective procedures, the quality of healthcare would improve for everyone. Building trades would get a piece of it when you consider medical physicality expansion and new construction. One item I’m wholeheartedly in favor of would be for Medicare to send a $50 check to each individual upon completion of annual physical examination including eyes & teeth. An ounce of preventation is worth a pound of cure.
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    The right to healthy life depends on access to affordable medical care. Please support this bill.
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    We've tried the market-based approach and found that the most vulnerable of us cannot afford care. It's time to take market forces and economic discrimination out of healthcare. Let's try centralized healthcare for a change and pick the best approach from other nation's plans that appear to do this well. Certainly this removes many opportunities for profit, but the profit motive hasn't produced what we need as a nation and as individuals at risk.
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    The inequity state-by-state of insurance availability, pricing and other barriers requires a one-payer system to be implemented.
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    I think we need some version of a National Health Care Program to be administered by a non-political, non-corporate, non-partisan body. The bottom line is that the profit motive and protection of shareholders is the prime cause of our soaring health care and drug costs. We MUST create a system that focuses on people, their access to care, innovative treatments, outcome based care, affordable life-sustaining medications like insulin, etc. Some years ago the Mayo Clinic created a very workable and interesting concept for a health care system. I highly suggest consulting care-giving systems such as the Mayo Clinic, the Cleveland Clinic and others like them as we consider transitioning away from a private insurance based system. Further, tax-exemptions should be removed from employers for providing health insurance and those dollars instead funneled into a National Healthcare system for every American.
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    Of couse I support Medicare for all
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    The Republican plan will take protection for pre-existing conditions. Our health care system is terrible. This will be the best way to fix it.
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